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Proximal medial gastrocnemius recession and stretching versus stretching as treatment of chronic plantar heel pain
Molund M, Husebye EE, Hellesnes J, Nilsen F, Hvaal K
Foot & Ankle International 2018 Dec;39(12):1423-1431
clinical trial
8/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Plantar heel pain is a common disorder that can lead to substantial pain and disability. Gastrocnemius recession has been described as an operative treatment option, but there is a lack of prospective clinical and biomechanical outcome data. The aim of this study was to evaluate the clinical and biomechanical outcomes of gastrocnemius recession and stretching compared with a stretching exercise protocol for patients with plantar heel pain lasting more than 12 months. METHODS: Forty patients with plantar heel pain lasting more than 1 year were randomized to a home stretching exercise program only or to surgery consisting of a proximal medial gastrocnemius recession in addition to stretching exercises. The main outcome was the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score at 12 months. Secondary clinical outcomes were the Short Form-36 (SF-36) and visual analogue scale (VAS) pain scores. The biomechanical outcome parameters were ankle dorsiflexion. Achilles function evaluated by a test battery with 6 independent tests, and plantar pressure evaluated by pedobarography. All data were obtained at baseline and at 12-month follow-up. RESULTS: The AOFAS score increased from 59.5 (42 to 76) to 88.0 (50 to 100; p < 0.001) for the operative group and from 52.5 (37 to 73) to 65.5 (31 to 88; p = 0.138) for the nonoperative group. The AOFAS, VAS pain, and SF-36 scores were significantly better in the operative compared with the nonoperative group at 12-month follow-up (p < 0.05). Ankle dorsiflexion increased from 6 degrees (-3 to 15) to 10.5 degrees (0 to 23; p < 0.001). No between-group difference was observed for Achilles function at follow-up. The average forefoot plantar pressure for the operative group increased from 536 KPa (306 to 708) to 642 KPa (384 to 885) at follow-up (p < 0.001). CONCLUSION: Proximal medial gastrocnemius recession with a stretching program was a safe and efficient method of treating chronic plantar heel pain. LEVEL OF EVIDENCE: Level 1, randomized clinical trial.

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